Why do kidneys fail?

Chronic kidney failure occurs when the tiny filters in the kidney (nephrons) that removes waste products stop working. Damage to the nephron can be caused by conditions such as diabetes and high blood pressure, congenital kidney disease and chronic glomerulonephritis which is a sort of inflammation in the kidneys. Slow and progressive deterioration of kidney function is called chronic kidney failure or chronic rental insufficiency. This means the kidneys are working at less than 50% of normal. It is usually irreversible. In some cases good control of Diabetes and hypertension may slow or even prevent the development of complete kidney failure or what we call end stage rental failure.

What are the treatments for chronic rental insufficiency?

There is no cure for chronic renal insufficiency. In the early stages proper food choices, medication and good blood pressure control may be all that is required to slow the damage to the kidneys. Once the kidneys are functioning at less than 10-20% of their normal rate, either dialysis or transplantation is needed to keep on living. This is called end – stage renal disease or ESRD. Your doctor will tell you when you need to start treatment based  on your medical condition and blood tests.

What is dialysis?

Dialysis is the way to clean the blood by removing waste products and excess water. Dialysis is used when kidneys are no longer working effectively and that is when around 90% of kidney function is lost. There are two types of dialysis. One is hemodialysis and the other is peritoneal dialysis.

During hemodialysis the blood is passed through an artificial kidney. The artificial kidney cleans the blood in almost the same way the healthy kidneys do. The treatment is performed usually three times a week. It can take between three to five hours each time. This would be a lifelong treatment unless a kidney transplant is done.

Hemodialysis can be doe in a hospital unit or at home with help of a partner. Special training is required for home dialysis.

Peritoneal dialysis works on the same principle as hemodialysis. But the blood is cleaned inside the body rather than through an artificial kidney. Your abdomen has a peritoneal cavity lined by a thin membrane called the peritoneum that surrounds the intestines and other internal organs.

Your doctor will tell you the right time for dialysis by doing blood and urine tests and checking overall health condition of your body and that should be before life threatening complications occur.

Why is a kidney transplant?

A kidney transplant is another treatment option for people with Kidney Failure. It is now widely considered to be the best way of treating kidney failure. However it is not suitable for everyone. Speak to your doctor to see if a kidney transplant is right for you.

A Kidney transplant is an operation where a healthy donated kidney is transplanted into your body. The transplanted kidney may come from a living person (living donor) or from a person who has died suddenly (cadaveric or non living donor). The transplant operation takes two to four hours. After the surgery people need to take anti rejection medication everyday, which are essential medicines. So your body will not try to get rid of the transplanted kidney considered foreign part to it. Regular blood tests are also needed in order to watch for any signs of rejection. It is hard to say how long a kidney transplant will last, although some kidneys have lasted longer than 25 years.

All the three modalities of treatments 9Peritoneal dialysis, hemodialysis and transplant) are called rental replacement therapy.

What symptoms may occur with chronic renal insufficiency? (CRI)

Usually CRI starts slowly and progresses over a number of years. During the early stage, there may be no warning symptoms, later as the kidneys continue to fail, more waste products like urea build up in the blood. This condition is called uremia and can make you feel sick. Anaemia can also occur. This is a reduced amount of red blood cells in the blood and can make you feel very weak and tired. It occurs due to the loss of kidney function to produce the hormone erythropoietin (EPO), which helps to make red blood cells. So you may need to take iron supplements in the form of injections or tablets with you doctor’s prescription. Regular in the form of injections or tablets with your doctor’s prescription. Regular injections of an artificially synthesized EPO are also available to treat the Anaemia of CRI.

Why to follow the renal diet?

The renal diet can,

Slow the progression of renal failure.

Delay the necessity for dialysis.

Prevent further complications of the disease in patients on dialysis, i.e. fluid overload, hypertension (high blood pressure) hyperkalemia (high potassium).

Maintain life until a kidney is available for a transplant.

Control the effects of high blood sugars if you have diabetes.

Reduce symptoms like nausea, fatigue, itching and bad taste in the mouth.

Meet you nutritional needs.

Control the build up of food wastes.

Each person has different needs depending on their age, medical history, weight and kidney functions. Together you and your dietitian will a daily eating plan according to your choice and your medical status with your doctor’s advice.

But in general you must know the nutrients that you have to restrict during chronic renal insufficiency (Predialysis stage) and dialysis in order to:

To relieve symptoms

Control blood pressure

Maintain good health

The Important nutrients to be controlled are:

Protein

Sodium

Potassium

Phosphorus

Fluid

Fats.

If you have diabetes, it is important to watch your carbohydrates (sugar and sweets) for better blood sugar control.

Protein:

Protein builds, repairs and maintains your body tissues. It also helps your body fight infection and heals wounds. As your body breaks down protein foods, a waste product called urea is formed. If this is not eliminated (during kidney failure) too much urea in the blood may cause tiredness, nausea (vomiting sensation), headache and a bad taste in your mouth. If you eat too little protein, you may lose muscle and weight, lack energy and have difficulty fighting infection. You must discuss with your dietitian how much protein to be taken according to your body weight.

The best protein for you (high quality protein) comes from animal sources such as eggs, meats, fish, chicken, milk and milk products like yogurt, cheese, buttermilk and ice-cream. These kinds of protein foods improve albumin level on your blood which is an important indicator of nutrition. Select always lean meat (without fat). This will help in controlling the blood cholesterol. Remove skin and bone before weighing each cooked portion. Although animal protein is of high quality we may supplement it with some plant protein for variation and since animal protein ay contain high phosphates which need restriction as well.

The amount of protein varies according to the stage of kidney failure. The National Renal Diet (USA) recommends

Predialysis stage (before any dialysis required)

Very low protein diet is advised (0.6-0, 8 g/kg of body weight/day)

During Dialysis

A slighty higher protein intake is advised to prevent protein malnutrition in this stage. (1.1 – 1.4 g/kg of body weight/day), a more liberal protein intake on peritoneal dialysis.

After transplant

After surgery the first month a high protein diet (1.3 – 1.5 g/kg of body weight) is advised to help the body in tissue repairing process. After the first month the intake should be normal (1.0g/kg of body weight) if the body accepts the transplanted kidney.

Here is a chart where you can choose your protein foods

Foods	Recommended	Avoid or use sparingly
Lamb and Beef	Leg, ribs and shoulder part of the animal	Minced meat, sausage, processed items like burgers
Poultry	Skinless chicken and turkey	Poultry skin, sausage, processed chicken items
Organ meats	Liver (limit to 3oz (90 gms) per month)	Chicken liver, gizzard, heart and kidney
Soy bean products	Raw tofu (soybean curd)	Anything added to ground meat
Egg	Whole (1 large)                                       Egg whites (2 large)	Too much of egg yolks
Cheese (limit to 3 times a week)	Low sodium, low fat cheese (2oz)-akkawi, cottage cheese (paneer)	All other cheese and cheese spreads

Choose the food items from the “recommended” column. All the items in the “avoid” column are high in saturated fats and many are high in sodium as well.

Sodium

Sodium is a mineral that is found naturally in foods and is part of the table salt, which is a major source of our sodium supply. Some salt or sodium supply. Some salt or sodium is needed for body’s water balance. When the kidney loses its function, this is altered.

What are the effects of too much Sodium?

When your kidney lose the ability to regulate water and sodium, you may experience the following

Thirst

Fluid gain in the body (edema)

High blood pressure

Discomfort during dialysis

By using less sodium in your diet, you can control the symptoms.

Tips to keep your sodium intake down

1. Cook with herbs and spices in place if salt.

2. Read food label when you buy a product and choose those foods sodium free or very low sodium.

3. Avoid salt substitutes and specially low sodium foods made with salt substitutes because they are high in potassium

4. When eating out ask for meat or fish without salt. Ask about the gravy or sauce on the side, as these may contain large amount of salt and should be used in small amounts.

5. Limit use of all canned, processed and frozen foods.

6. Know your sodium allowance by asking your doctor or dietitian. Remember that there are 1000 milligrams (mg) in 1 gram (g). For e.g. If your diet prescription is 2 gram of sodium, your limit is 2000 mg per day. Consider the sodium value of other food to be eaten during the day.

The following table gives you the foods that has to limited :

Limit the amount of :	Foods to limit	Acceptable substitutes
Salt and salt seasonings	Table salt, soup cubes lite salt, noodle mixes baking powder, baking soda and monosodium glutamate (MSG)	Fresh garlic, fresh onion garlic powder, onion powder, black pepper lemon juice, salt free seasonings and vinegar.
Salty foods	High sodium sauces such as Barbecue sauce, soy sauce mustard souce, Worces tershire sauce and all commercial sauces. Salted snacks such as Crackers, potato chips, corn chips, nuts, tortilla chips, salted seeds salted popcorn.	Home made or low sodium sauces and salad dressings like vinegar, dry mustard unsalted corn chips and popcorn.
Cured foods                (Preserved foods)	Pickles and salted olives
Processed foods	Buttermilk, cheese spreads	Salt free natural cheese
	Hot dogs, sausages burgers, any processed meat items, salted fish (dry fish)	Include fresh beef, lamb, chicken, fish and eggs.
	Commercial soups, vegetable juices, tomato products, canned vegetables.	Home made low sodium soups, canned foods without salt.
	Ready to eat foods, frozen prepared foods, coomercial mixes (cake mix), fast foods (Pizza, Kentucky, burger)	Home made fresh foods without added salt.

You can season your food without salt by using the following herbs and spices.

Basil                                         Cumin                                       mint

Bay leaves                                Curry Powder                             dry mustard

Cardamom                                Dill                                            Nutmeg

Chilli Powder                             Fennel                                      Onion

Coriander leaves                        Garlic                                        Oregano

Cinnamon                                  Ginger                                       Paprika

Cloves                                       Lemon/lime                               Parsley

Coriander seeds                         Mace                                        Saffron and Turmeric

You can mix any of the above mentioned herbs and spices according to your taste and flavor your dishes using them instead of salt.

Potassium

Potassium is a mineral found in many of the foods you eat. It pays a role in keeping your heartbeat regular and your muscles working right. It is the job of the kidneys to keep the right amount of potassium in your body. However, when your kidneys no longer work well, it is your job to watch you potassium intake by avoiding foods that are high in potassium.

Safe potassium level

Green light        - 3.5 – 5.0 mmol/L

Caution light      - 5.0 – 6.0 mmol/L

Red light           - more than 6 mmol/L

Ask your doctor or nurse what your blood potassium level is each time you have an appointment.

Keep track of this number, it is very important.

What happens if the potassium level is high

• Muscle weakness

• Irregular heart beat

• Cardiac arrest (heart stands still) and sudden death

The way to prevent high potassium

• Predialysis (before dialysis) patients should be aware of medications that raise potassium : (Non steroidal anti inflammatory drugs 9like voltarean), B blockers (like tenormin).

• Restrict the potassium in your diet by choosing foods low in potassium and using special techniques of food preparation like putting foods with high potassium in large amount around its ten folds amount of water for sometime to allow potassium to leak and then to discard the water and cooking high potassium contacting foods in large amounts of water which is discarded at the end. So cooking with steam or cooking in little water are not suitable for potassium restricted diets.

• Stay on dialysis the prescribed amount of time.

• Do not skip dialysis treatment.

Remember  : Salt substitutes contain potassium and can be very dangerous for kidney patients.

Salt substitute brands :

Note: Cardia No-salt, Nu-salt, Lo-salt and Morton Lite salt.

         Many soups are very high in potassium because it has “leaked” out of vegetables into the broth.

The following table gives you the foods that are high in potassium ½ cup per choice or as indicated in the case of fruits and vegetables.

HIGH POTASSIUM FOODS (201 mg – 350 mg)

FRUITS	VEGITABLES	OTHER FOODS
Apricots, canned or fresh (2 halves)                                            Apricots dried (5)                               Banana (1/2 medium)                         Dates (1/4 cup)                              Figs dried (2 whole)                      Honeydew melon (1/8 small)            Kiwi fruit (1/2 medium)                         Nectarine (1 small)                          Orange Juice ( 1 small)                      Prune Juice                                    Prunes dried or canned (5)              Sweet melon (1/8 small)	Asparagus ( 5 spears)                       Avocado (1/4 whole)                        Beets                                                Celery cooked                                  Mushroom (fresh & cooked)        Okra                                             Pepper, chilli                                      Potato (boiled or mashed)               Pumpkin                                   Tomato (1 medium) &                        Tomato products                             Mulukkiya (kind of leafy vegetables)                                                       Spinach                                       Dried Beans (White, red, kidney, black & all other kinds) Dried Peas (chick pea, cow pea, lentils & all other kinds)	Bran                             Bran Proudcts (wholemeal bread) Coffee (limit 2 cups/day)                            Chocolate                  Coconut                          Granola bars               Ice cream  Molasses (Jaggery) Nuts & Seeds (all kinds)

The following table gives you the foods that are medium in potassium ½ cup per choice or as indicated in the case of fruits and vegetables.

Medium Potassium Foods (101-200 mg)
FRUITS	VEGETABLES
Apple ( 1 small) Apple Juice Apricot nector Blackberries Cherries (sour or sweet) Figs, canned Fruit cocktail Grapes (15 small) Grapefruit (1/2 small) Grapefruit Juice Gooseberries Lemon Juice Mango Papaya Mango Peach (canned) Peach fresh ( 1 small) Pineapple ( canned or fresh) Plums ( 1 medium) Raisins ( 2 tabs) Strawberries Tangerine or mandarin ( 1 small) Water melon ( 1 cup)	Broccol Cabbage, cooked Carrots ( 1 small raw) Cauliflower Celery, raw ( 1 stalk) Corn Eggplant Mushroom (canned) Onion Green peas Radish Squash ( marrow, white pumpkin, Bottle gourd, snake guard) Turnip Mixed vegetables

The Following foods are low in potassium ½ cup per choice or as indicated in the case of fruits and vegetables.

LOW POTASSIUM FOODS (below 100 mg)
FRUITS	VEGETABLES	OTHER FOODS
Blueberries Cranberries ( 1 cup) Cranberry cocktail ( 1 cup) Grape Juice (1/2 cup) Lemon (1/2) Papaya nectar Peach nectar Pears ( 1 small) Pear nectar	Green beans Bean Sprouts Cabbage (raw) Chinese cabbage (raw) Cucumber (peeled) Lettuce all varieties ( 1cup) Sweet Green Pepper (Capsicum)	Rice Noodles Bread (not wholemeal) Bread products (not wholemeal) Cereals Cakes Cookies

Till you get your personalized meal plan, National Renal Diet recommends

Choose no more than 3 fruit servings each day. Select 1 serving from medium potassium fruits and 2 serving from low potassium foods listed in the table.

Limit vegetables to 2 servings each day. One serving is ½ cup cooked or 1 cup of raw vegetables (salad). Include one vegetable from medium potassium foods and one from low potassium foods listed in the table.

Phosphorus

Phosphorus is a mineral, which normally keeps your bones strong and healthy. Along with calcium, phosphorus is needed for building healthy, strong bonts.

Normal working kidneys can excrete excess phosphorus in food. When your kidneys fail, eating too many foods high in phosphorus can cause your blood phosphorus level to get too high. It may cause

• Itchy skin

• Painful joints

• Weak bones

• Advances renal failure  

How to Control?

You can keep you blood phosphorus level normal by controlling the amount of phosphorus in your diet. Also, your doctor may or order a medicine called a phosphate binder for you to take with your meals and snacks. This medicine binds some of the phosphorus in your food and sends it through your stool. 

When phosphorus in your blood gets too high, try avoiding the following high phosphorus foods for a while. 

High Phosphorus Foods 

• Milk and milk products including cheese (especially hard cheese, processed cheese, soft cheese, sheep cheese, mozzarella), cottage cheese, ice cream, custard, puddings, yogurt and soups made with milk.

• All kinds of dried beans and peas, Nuts and seeds.

• Meat, fish and seafood, poultry, entrails, fish roe (eggs)

• Beverages or drinks such as beer, dark colas, drinks made with milk, cocoa and chocolate.

• Other foods such as chocolates, wheat germ, whole grain products 9brown breads), Caramels, yeast, bran and bran products, peanut and Tahina (sesame seed paste).

• Processed foods to which phosphate is added during the production process (e.g. for conservation reasons); have a look at the label for substances with “phosphorus” or “phosphate” in their names.  

Better Choices

• Instead of Milk use Non-dairy creamers e.g. Coffee-mate.

• Cheeses with moderate phosphorus content : cream cheese, curd, cottage cheese

• Instead of Custard use Jelly

• Instead of  Ice cream use Sorbet

• Instead of wholemeal products use white breads and Home made baked items.

• For cooking and baking use a mixture of 1/3 cream and 2/3 water instead of milk.  

REMEMBER 

In order to work effectively, you must take your phosphorus binders just before the bite of food each time you eat a snack or meal. 

Fluid Restriction

The kidneys in renal failure also lose the ability to handle excessive amounts of fluid. Therefore, you may be on a fluid restriction to prevent fluid overload. Fluid excess in a patient with renal disease can lead to shortness of breath, high blood pressure and can endanger your life. The information below will help you to follow a fluid restriction. Ask your doctor what your exact fluid restriction level is.

A body usually needs 500 ml of fluids extra to its losses a day in cold climates and between 750 – 1000 ml in hot climates.

1 cup of fluid (8 ox) = 240 ml 

A FLUID IS ANYTHING THAT IS LIQUID AT ROOM TEMPERATURE 

The following foods are considered as fluids

Water Cream Ice Milk Coffee All Juices

Jelly Soup Salad dressing (mayonnaise) Tea

Ice cream Fruit ice Sherbet Syrups Soda pudding

For e.g.

1 Tablespoon of mayonnaise                   = 30 ml of fluid

1 Cup of milk                                         = 240 ml of fluid

1 Cup ice cream/pudding/sherbet 94 oz)  = 120 ml of fluid 

Tips for managing thirst

• Chew gum to quench thirst

• Drink lemonade instead of water

• Suck on a frozen lemon wedge (limit to 2 a day)

• Wash you mouth with mouthwash

• Ice cold liquids satisfy thirst better than room temperature

• You can suck on ice. Count one cup of ice as one half cup of water.

• Avoid high sodium in diet

Is fiber necessary?

Yes. Fiber is found naturally in many foods. It adds extra bulk to your foods. This can help prevent overeating, and decrease hunger between meals.

Fiber has many health benefits. It helps prevent constipation that may be caused by the medicines e.g. Phosphate binders you are taking. It also helps lower blood cholesterol and triglyceride Fiber also can help lower blood sugar for people with diabetes. 

Because “Many high fiber foods are also high in potassium and phosphorus, the renal patient must be careful” when choosing foods that are a good source of fiber.

Tips for preventing constipation

• Eat all the fruits an dvegetables planned for you each day in your diet.

(Select from the low and medium potassium fruits and vegetable list).

• Drink all the fluid, which is allowed for you.

• Exercise can be helpful in alleviating constipation. Ask doctor what type of exercise can be right for you.

Begin adding high fiber foods to your daily intake, but do so slowly, increasing fiber too quickly may cause gas, bloating and cramps.

Try to include at least one high fiber food like the following in each meal:-

Quaker Oats                  -           ½ cup cooked

Shredded Wheat            -           1 biscuit

Quaker Corn                  -           ¾ cup cooked

Brown rice                     -           ½ cup cooked

Unsalted popcorn           -           ½ cup 

Why Vitamin Supplement

Vitamins are very important to all metabolic functions of the body. Vitamins play a part in controlling the body’s ability to burn fat and sugar for energy and build proteins for growth. If vitamins are deficient, these reactions are not properly coordinated and may cause skin problems, muscle weakness, tiredness and nerve pain. These can be signs that vitamin supplements may be necessary.

There are 4 reasons why kidney patients have different vitamin requirements than healthy individuals:

• A typical diet for kidney patient is low in B-complex vitamins

• In Kidney disease “Uremic toxins” will accumulate which interfere with absorption or activity of some vitamins.

• Drugs taken for other illnesses may interface with absorption or activity of some vitamins.

• Dialysis may lead to loss of water-soluble vitamins.  

Your doctor will prescribe a special multi vitamin designed for people with kidney disease. If you receive dialysis on the morning shift, be sure to take your prescribed multi-vitamin after dialysis. Otherwise, take it first thing in the morning (and again at bed time if you take it twice a day)

What about herbal remedies and health food?

Before you take any kind or herbal remedy or health food, discuss this with your dietitian and doctor. These substances may create serious problems for someone with kidney disease.

Should I Control my Fat intake?

Dialysis patients have a greater risk of developing heart disease due to increased blood level of lipid like cholesterol. Being careful with the amount and the type of fat you eat, can decrease your chances of heart disease.

• Use monounsaturated fat frequently (Olive Oil, canola oil)

• Polyunsaturated fasts like corn oil, sunflower oil and safflower oil are beneficial to your health an reduce the cholesterol levels.

Saturated fats (like in butter, whole milk (Full cream). Cheese, ice cream, fatty red meat (lamb, beef) and sausage, palm oil, palm kernel oil, coconut oil and fats with trans-fatty acids which are built during hydrogenation of vegetable oil (e.g. in margarine and vegetable ghee) are linked to heart disease.

Current recommendations are 1/3 of mono saturated. 1/3 mono saturated. 1/3 polyunsaturated and 1/3 saturated fatty acids.

Starting your renal diet till you get your personalized meal plan 

Until your receive an individualized diet plan from the dietitians of your hospital here are some general guidelines to follow.

1. Salt should no be added to your food. To season foods use herbs and non salt type spices. Onion, garlic powder, lemon and vinegar are good choices. Avoid salt substitutes they are loaded with potassium.

2. Try to include high quality protein foods daily (lean meat, fish, chicken and eggs). One serving is 1 oz (30 grams). Limit total of 8 oz (240 grams) daily. Natural cheese like cheddar, cottage and Swiss cheese may be used in small amounts. Avoid processed cheese and salted, canned, cured meats. Regular tuna can be used if rinsed with water to reduce the sodium. If you are not yet treated with dialysis a low protein diet may be necessary depending on the stage of your renal failure. In this case, please ask your doctor or dietitian for assistance.

3. Limit milk, yogurt, ice cream or sherbet to just one ½ cup serving a day. Non dairy creamers such as coffee-mate (up to one cup per day) can be used in addition to milk.

4. Avoid nuts, seeds dried beans, lentils and peanut butter. These foods are high in potassium and phosphorus and they make more waste products in your blood.

5. Choose no more than 3 fruit serving each day. One serving is ½ cup or 1 medium fresh fruit. Choose from the list of low and medium (not more than one serving) potassium fruit.

6. Limit vegetables to 2 serving each day. One serving is ½ cup cooled or 1 cup mixed salad. Choose the vegetables from the low potassium list.

7. Bread, crackers can be used in moderation. Stay away from salty snack foods like chips. Avoid brown cereals they are high in potassium. Oatmeal and plain dry cereal can be used.

8. Regular margarine, mayonnaise and oils (recommended in the fat list) can be used liberally. Unless you are a diabetic use sugar, honey and syrup for energy and calories.

9. Limit fluid intake to 5 cups or 40 ounces per day ( 8 ounces = 1 cup). Fluid such as water, coffee, tea, lemonade, 7-up and cranberry juice are okay to use. Anything that melts at the room temperature (ice cream, jelly, ice) also needs to be counted as fluid.  

If you are DIABETIC continue to eat meals and snacks at regular times and avoid concentrated sweets. In case of hypoglycaemia do not use fruit juice, it is high in potassium. Sweetened tea or pure glucose is a better choice. 

WHEN YOU ARE EATING OUT choose meats without sauce or gravies, avoid beans and fresh tomatoes, creams and Chinese food should be made without any Mono Sodium Glutamate (ask your sever) and extra soy sauce should be avoided, try not to take any food served with nuts.

Diet after Transplant

If you recently had an organ transplant, you are probably wondering if your diet will be different from the one you followed before your transplant. Yes, after an organ transplant, your diet still plays a big role. If you were on dialysis before and had kidney transplant, you may find that this diet is easier to follow than the one you were on for your dialysis.

Medications and Diet.

Your diet will be affected by the use of necessary medications given to prevent rejection of your transplant. Some common anti-rejection medications may affect your diet (e.g. Steroids). These medications may change the way your body works in the following ways:

• Increase in appetite causing unwanted weight gain

• Increase in level of blood fats like cholesterol or triglyceride.

• Increase in blood sugar levels

• Increase in sodium and fluid retention

• Increase in breakdown of muscle and bone

These effects are greater when steroid dosages are high. 

Weight Gain

Many people have a better appetite after they get a transplant, and they gain unwanted weight. Check your weight often. Avoid high-calorie foods such as fatty fried foods, sweets, pastries and other foods rich in fat or sugar. You can help control your calories by eating:

• Raw vegetables and fruits

• Lean met (meat without fat), Skinned poultry and fish

• Sugar free beverages

By controlling the weight, it helps to keep you from developing problems like heart disease, diabetes and high blood pressure.

If you gain unwanted weight, you need to increase your physical activity and follow a low-calorie diet.

Fat

Fat (cholesterol or triglyceride) levels in your blood may be high. High levels of cholesterol and triglyceride can cause heart disease. The following steps can lower the fat cholesterol in your blood.

• Use non-fat milk products

• Use lean meat, poultry and fish

• Use fat free salad dressing (avoid oil and mayonnaise as salad dressings)

• Use only small amounts of oil for cooking

• Avoid fried foods

• Avoid ghee, butter and margarine

• Avoid anything that says in the label “Hydrogenated” or “Partially hydrogenated” fats.

• Limit the intake of eggs yolks to three a week

• Avoid the intake of alcoholic beverages

• Lose weight if you are overweight by diet and exercise

• For desserts use fNT-SIZE: 8pt">They provide energy for the body to carry out our daily activities.

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Carbohydrates

You should know some important facts about carbohydrate foods.

• Carbohydrates come from sugars and starches (rice, wheat, potato, rice products and wheat products like all kinds of pasta)

• They provide energy for the body to carry out our daily activities.

• When you take steroid medication, it is difficult for your body to use extra carbohydrates. This can lead to high blood sugar levels and may cause diabetes. If you are diabetic already, it will lead to uncontrolled diabetes, which may, in turn in due course will lead to kidney failure.

For these reasons, you may limit the intake of “simple” carbohydrates, which includes sugar, sweets and sugared beverages like Pepsi and other similar drinks.

You can include ‘complex” carbohydrates such as pasta (macaroni, noodles, spaghetti), Unsweetened cereals (like oats, cornflakes), rice, khubus (pita bread) chapatti (flat bread), and other breads. 

Whether to continue a low-salt diet or not after transplant

Most of the patients after transplant still need to restrict salt. It may vary with each person. Transplant medications, especially steroids, may cause your body to retain fluid. Salt makes this problem worse, increasing fluid retention and raising blood pressure. Controlling blood pressure is very important to your transplant. Your doctor will decide how much sodium is best for you. 

If your Doctor advises to limit your sodium or salt intake, use the table given under Sodium heading for your guidance. 

Protein Intake

Your protein intake will need to higher than normal immediately after you transplant for one month.

• This helps you to heal after surgery.

• It builds up the muscle tissue that will be broken down by the large doses of steroids.  

Later, you can return to moderate amounts of protein. Your dietitian will tell you how much of protein to be taken according to your desirable body weight.

Potassium Intake

As long as your transplant is working well, you should be able to take normal amounts of potassium from your food. Some transplant medications can increase your blood level potassium, while other medications you take might decrease it. Depending on your blood level of potassium, your doctor will recommend to reduce or include potassium in your diet. In the case refer the tables containing high and low potassium foods. 

Calcium and Phosphorus

Your body probably lacks the balance of calcium and phosphorus needed for healthy bones, especially if you had kidney disease. So you may need to pay close attention to your calcium and phosphorus levels. When you undergo transplant, you are at risk for bone density loss. Your doctor will talk to you about possible bone loss and talk to you about the best ways to keep your bones healthy. In the meantime, every adult needs about two servings a day from the dairy group (milk, Yogurt and cheese) preferably non-fat or low fate milk products. Unless your doctor has told you not to use these foods, try to include them in your diet. Your doctor may advise you take supplement also. 

IF YOU HAVE DIABETES 

After a transplant, your new diet should have low calorie foods (mentioned before) and try avoid high calorie foods. Try to keep your blood sugar under control. Check your sugar regularly. 

NOTE

1. A Kidney transplant sometimes be slow in getting started. So the doctor will have to advise you to follow a renal diet for a while. This is needed only for a short time.

2. You may be asked to drink a lot of water (something you were told to stay away from the past).  

REMEMBER 

If your doctor and dietitian tell you to change what your eat or drink, it is very important for your health and your transplant that you do so. 

While occurrence of kidney disease is widespread and increasing in this part of the world, at the same time knowledge and treatment methods are getting reliably sophisticated and available. Diet as part of the treatment plays an important role in the management of kidney disease. We hope this modest work could be of help to the “patients” who are most important to us.